NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS NOV 25 2025 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT
CAROLINE HARRIS, No. 24-6904 D.C. No. Plaintiff - Appellant, 2:22-cv-01885-DLR v. MEMORANDUM* FRANK BISIGNANO, Commissioner of Social Security,
Defendant - Appellee.
Appeal from the United States District Court for the District of Arizona Douglas L. Rayes, District Judge, Presiding
Submitted November 21, 2025** Phoenix, Arizona
Before: MURGUIA, Chief Judge, and HAWKINS and HURWITZ, Circuit Judges.
Caroline Harris appeals the district court’s judgment affirming the Social
Security Commissioner’s denial of her application for Social Security Disability
Insurance. Harris seeks disability benefits on account of cervical spondylosis,
* This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3. ** The panel unanimously concludes this case is suitable for decision without oral argument. See Fed. R. App. P. 34(a)(2). Ehlers-Danlos syndrome, mast cell activation syndrome, and migraines, among
other impairments. An Administrative Law Judge (“ALJ”) found that Harris has the
residual functional capacity (“RFC”) to perform sedentary work, with some
limitations. The ALJ also found Harris capable of performing her past relevant work
as a medical clerk.
We review the district court’s decision affirming the ALJ’s denial of benefits
de novo and will reverse only if the ALJ’s decision is not supported by substantial
evidence or if the ALJ applied the wrong legal standard. Molina v. Astrue, 674 F.3d
1104, 1110 (9th Cir. 2012) (citations omitted), superseded on other grounds by 20
C.F.R. § 404.1502(a). Substantial evidence is “more than a mere scintilla . . . and
means only such relevant evidence as a reasonable mind might accept as adequate
to support a conclusion.” Biestek v. Berryhill, 587 U.S. 97, 103 (2019) (cleaned up)
(citation and internal quotation marks omitted). We affirm.
1. The ALJ properly discounted the medical opinion evidence of Drs. David
Saperstein, Ronald Jorgensen, and Farjallah Khoury. An ALJ should consider
several factors when assessing the persuasiveness of a medical opinion, including
supportability, consistency, relationship with the claimant, and specialization of the
medical source. 20 C.F.R. § 404.1520c(c). Of these factors, supportability and
consistency are the most important. Id. at § 404.1520c(a). An ALJ must discuss the
persuasiveness of each medical opinion and explain how the ALJ “considered the
2 24-6904 supportability and consistency factors” in reaching these issues. Id. at
§ 404.1520c(b)(2).
The ALJ properly discounted Dr. Saperstein’s checkbox opinions, which
concluded, without explanation, that Harris has impairments that preclude an eight-
hour workday. See Kitchen v. Kijakazi, 82 F.4th 732, 740–41 (9th Cir. 2023) (“[W]e
have accepted the discounting of a medical opinion set forth in a checkbox form with
little to no explanation.”) (citing Ford v. Saul, 950 F.3d 1141, 1155 (9th Cir. 2020)).
Dr. Saperstein checked boxes indicating that Harris can, in an eight-hour workday,
sit for less than two hours, lift less than ten pounds, stand or walk less than two
hours, and carry less than ten or fifteen pounds. The ALJ properly concluded that
these opinions were not supported by objective medical evidence, including Dr.
Saperstein’s own notes that document normal vitals and do not include objective
evaluations regarding Harris’s limitations that support his conclusions. See Stiffler
v. O’Malley, 102 F.4th 1102, 1107 (9th Cir. 2024) (quoting Ford, 950 F.3d at 1154)
(“‘The ALJ need not accept the opinion of any physician, including a treating
physician, if that opinion is brief, conclusory, and inadequately supported by clinical
findings.’”). The ALJ also noted that objective testing, including neurological
testing, revealed normal findings and that other physician reports showed generally
normal findings.
Similarly, the ALJ properly discounted Dr. Jorgensen’s checkbox opinion,
3 24-6904 which also concluded, without explanation, that Harris has impairments that
preclude an eight-hour workday. Although the ALJ failed to address the consistency
factor, see 20 C.F.R. § 404.1520c(b)(2), any error was harmless because Dr.
Jorgensen’s checkbox opinions are the same as Dr. Saperstein’s checkbox opinions.
Because the ALJ found Dr. Saperstein’s opinion inconsistent with the evidence from
other medical sources, the same conclusion applies to Dr. Jorgensen’s opinion. As
to supportability, the ALJ properly concluded that Dr. Jorgensen’s opinion was
unsupported by the objective medical evidence and therefore unpersuasive. The ALJ
correctly stated that Dr. Jorgensen’s clinic notes do not contain objective medical
evidence that supports his opinion about Harris’s physical abilities. See Kitchen, 82
F.4th at 740 (substantial evidence supported the ALJ’s finding that a doctor’s
opinion was unpersuasive where the doctor’s assessment of severe limitations was
inconsistent with the doctor’s own “unremarkable” examinations).
Finally, the ALJ properly discounted the opinion of Dr. Khoury, who opined
that Harris suffers from severe fatigue, based on chronic migraine headaches and
insomnia secondary to her conditions, and cannot complete an eight-hour workday.
The ALJ relied on substantial evidence, including evidence that Harris’s migraine
treatments were improving her condition. The ALJ also reviewed Harris’s activities
of daily living and concluded that Harris’s ability to provide care to her minor
children, prepare simple meals, and grocery shop is inconsistent with Dr. Khoury’s
4 24-6904 finding that Harris is unable to complete a workday due to headaches and insomnia.
2. The ALJ “provide[d] ‘specific, clear and convincing reasons for’ rejecting
[Harris’s] testimony regarding the severity of [her] symptoms.” See Treichler v.
Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1102 (9th Cir. 2014) (quoting Smolen
v. Chater, 80 F.3d 1273, 1281 (9th Cir. 1996)). For example, the ALJ reviewed the
medical record about Harris’s back pain and concluded that, although she
experiences a degree of limitation, it is inconsistent with the alleged severity of her
cervical spine pain. See Smartt v. Kijakazi, 53 F.4th 489, 498 (9th Cir. 2022) (“When
objective medical evidence in the record is inconsistent with the claimant’s
subjective testimony, the ALJ may indeed weigh it as undercutting such testimony.”)
(emphasis in original). Despite Harris’s symptom testimony that fatigue limited her
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NOT FOR PUBLICATION FILED UNITED STATES COURT OF APPEALS NOV 25 2025 MOLLY C. DWYER, CLERK U.S. COURT OF APPEALS FOR THE NINTH CIRCUIT
CAROLINE HARRIS, No. 24-6904 D.C. No. Plaintiff - Appellant, 2:22-cv-01885-DLR v. MEMORANDUM* FRANK BISIGNANO, Commissioner of Social Security,
Defendant - Appellee.
Appeal from the United States District Court for the District of Arizona Douglas L. Rayes, District Judge, Presiding
Submitted November 21, 2025** Phoenix, Arizona
Before: MURGUIA, Chief Judge, and HAWKINS and HURWITZ, Circuit Judges.
Caroline Harris appeals the district court’s judgment affirming the Social
Security Commissioner’s denial of her application for Social Security Disability
Insurance. Harris seeks disability benefits on account of cervical spondylosis,
* This disposition is not appropriate for publication and is not precedent except as provided by Ninth Circuit Rule 36-3. ** The panel unanimously concludes this case is suitable for decision without oral argument. See Fed. R. App. P. 34(a)(2). Ehlers-Danlos syndrome, mast cell activation syndrome, and migraines, among
other impairments. An Administrative Law Judge (“ALJ”) found that Harris has the
residual functional capacity (“RFC”) to perform sedentary work, with some
limitations. The ALJ also found Harris capable of performing her past relevant work
as a medical clerk.
We review the district court’s decision affirming the ALJ’s denial of benefits
de novo and will reverse only if the ALJ’s decision is not supported by substantial
evidence or if the ALJ applied the wrong legal standard. Molina v. Astrue, 674 F.3d
1104, 1110 (9th Cir. 2012) (citations omitted), superseded on other grounds by 20
C.F.R. § 404.1502(a). Substantial evidence is “more than a mere scintilla . . . and
means only such relevant evidence as a reasonable mind might accept as adequate
to support a conclusion.” Biestek v. Berryhill, 587 U.S. 97, 103 (2019) (cleaned up)
(citation and internal quotation marks omitted). We affirm.
1. The ALJ properly discounted the medical opinion evidence of Drs. David
Saperstein, Ronald Jorgensen, and Farjallah Khoury. An ALJ should consider
several factors when assessing the persuasiveness of a medical opinion, including
supportability, consistency, relationship with the claimant, and specialization of the
medical source. 20 C.F.R. § 404.1520c(c). Of these factors, supportability and
consistency are the most important. Id. at § 404.1520c(a). An ALJ must discuss the
persuasiveness of each medical opinion and explain how the ALJ “considered the
2 24-6904 supportability and consistency factors” in reaching these issues. Id. at
§ 404.1520c(b)(2).
The ALJ properly discounted Dr. Saperstein’s checkbox opinions, which
concluded, without explanation, that Harris has impairments that preclude an eight-
hour workday. See Kitchen v. Kijakazi, 82 F.4th 732, 740–41 (9th Cir. 2023) (“[W]e
have accepted the discounting of a medical opinion set forth in a checkbox form with
little to no explanation.”) (citing Ford v. Saul, 950 F.3d 1141, 1155 (9th Cir. 2020)).
Dr. Saperstein checked boxes indicating that Harris can, in an eight-hour workday,
sit for less than two hours, lift less than ten pounds, stand or walk less than two
hours, and carry less than ten or fifteen pounds. The ALJ properly concluded that
these opinions were not supported by objective medical evidence, including Dr.
Saperstein’s own notes that document normal vitals and do not include objective
evaluations regarding Harris’s limitations that support his conclusions. See Stiffler
v. O’Malley, 102 F.4th 1102, 1107 (9th Cir. 2024) (quoting Ford, 950 F.3d at 1154)
(“‘The ALJ need not accept the opinion of any physician, including a treating
physician, if that opinion is brief, conclusory, and inadequately supported by clinical
findings.’”). The ALJ also noted that objective testing, including neurological
testing, revealed normal findings and that other physician reports showed generally
normal findings.
Similarly, the ALJ properly discounted Dr. Jorgensen’s checkbox opinion,
3 24-6904 which also concluded, without explanation, that Harris has impairments that
preclude an eight-hour workday. Although the ALJ failed to address the consistency
factor, see 20 C.F.R. § 404.1520c(b)(2), any error was harmless because Dr.
Jorgensen’s checkbox opinions are the same as Dr. Saperstein’s checkbox opinions.
Because the ALJ found Dr. Saperstein’s opinion inconsistent with the evidence from
other medical sources, the same conclusion applies to Dr. Jorgensen’s opinion. As
to supportability, the ALJ properly concluded that Dr. Jorgensen’s opinion was
unsupported by the objective medical evidence and therefore unpersuasive. The ALJ
correctly stated that Dr. Jorgensen’s clinic notes do not contain objective medical
evidence that supports his opinion about Harris’s physical abilities. See Kitchen, 82
F.4th at 740 (substantial evidence supported the ALJ’s finding that a doctor’s
opinion was unpersuasive where the doctor’s assessment of severe limitations was
inconsistent with the doctor’s own “unremarkable” examinations).
Finally, the ALJ properly discounted the opinion of Dr. Khoury, who opined
that Harris suffers from severe fatigue, based on chronic migraine headaches and
insomnia secondary to her conditions, and cannot complete an eight-hour workday.
The ALJ relied on substantial evidence, including evidence that Harris’s migraine
treatments were improving her condition. The ALJ also reviewed Harris’s activities
of daily living and concluded that Harris’s ability to provide care to her minor
children, prepare simple meals, and grocery shop is inconsistent with Dr. Khoury’s
4 24-6904 finding that Harris is unable to complete a workday due to headaches and insomnia.
2. The ALJ “provide[d] ‘specific, clear and convincing reasons for’ rejecting
[Harris’s] testimony regarding the severity of [her] symptoms.” See Treichler v.
Comm’r of Soc. Sec. Admin., 775 F.3d 1090, 1102 (9th Cir. 2014) (quoting Smolen
v. Chater, 80 F.3d 1273, 1281 (9th Cir. 1996)). For example, the ALJ reviewed the
medical record about Harris’s back pain and concluded that, although she
experiences a degree of limitation, it is inconsistent with the alleged severity of her
cervical spine pain. See Smartt v. Kijakazi, 53 F.4th 489, 498 (9th Cir. 2022) (“When
objective medical evidence in the record is inconsistent with the claimant’s
subjective testimony, the ALJ may indeed weigh it as undercutting such testimony.”)
(emphasis in original). Despite Harris’s symptom testimony that fatigue limited her
ability to engage in prolonged activity, the ALJ found that there was a record of
alertness and that the medical record demonstrated that Harris’s treatment was
helpful. As to Harris’s testimony regarding migraines, the ALJ relied on evidence
suggesting treatments were effective. Although Harris argues that her migraines did
not improve such that she can work full time, “[w]here the evidence is susceptible
to more than one rational interpretation, the ALJ’s decision must be affirmed.” Id.
at 494 (citation omitted).
Finally, the ALJ noted that Harris reported performing some largely
independent daily activities, including driving a car, caring for minor children, and
5 24-6904 grocery shopping, but found these activities to be inconsistent with the severity of
Harris’s allegations of cervical spine pain, migraines, generalized joint and muscle
pain, and fatigue. Harris argues that the ALJ failed to consider that she needs help
from family members to engage in her activities of daily living, such as child care;
however, “even if [Harris’s] explanation is a rational one, we will not disturb the
ALJ’s differing rational interpretation where the ALJ’s interpretation is adequately
supported.” Coleman v. Saul, 979 F.3d 751, 756 (9th Cir. 2020).
By identifying inconsistencies between Harris’s symptom testimony and the
objective medical record, improvements with medication, and Harris’s activities of
daily living, the ALJ provided specific, clear, and convincing reasons for rejecting
Harris’s testimony regarding the severity of her symptoms.
AFFIRMED.
6 24-6904